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Enucleation, Evisceration and Exenteration of the Eye.
  1. JOHN PITTS

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    Enucleation, Evisceration and Exenteration of the Eye. Ed Michael E Migliori. Pp 300; £110. Oxford: Butterworth-Heinemann, 1998. ISBN 0-7506-9495-5

    This 10 chapter, multiauthor text covers the topic of removal of the eye in extensive detail, but is concise enough to retain a manageable size.

    The chapters are comprehensively referenced, in keeping with sound evidence based practice, but each author was asked to include his own preferences and biases; this lends itself to a readable, practical, and personal account of the various clinical options available. The illustrations are clear and appropriate to the points in the text.

    The history of removal of the globe, prosthetics, and implantation are blended into the text in an appealing manner, and the authors bring the topic up to date with modern biomaterials such as hydroxyapatite and porous polyethylene. In addition to the science, there is a strong emphasis on treating the whole patient and, in particular, recognising the psychological impact of loss. Due attention is paid to medicolegal considerations, including the necessity of obtaining a written second opinion that enucleation is necessary.

    The disease states necessitating enucleation are briefly discussed, and there is a balanced, evidence based review of the controversy surrounding sympathetic ophthalmia and its prevention. The indications for enucleation, evisceration, and exenteration are discussed and strategies for dealing with complications of surgery are detailed.

    There is an outstanding chapter on the role of the ocularist. This is eminently readable and informs the surgical reader of the highly skilled work of the ocular prosthetist and the importance of involving one at the planning stage. Non-surgical treatment options such as the use of contact lenses and scleral shells are beautifully described and illustrated.

    There are detailed sections on harvesting autogenous materials for wrapping implants and socket repair; no mention is made of newly described techniques such as the upper thigh incision for harvesting fascia lata or the use of retroauricular muscle as a wrapping material.

    The authors refer to the avoidable tragedy of removing the wrong eye, and to the risk of transmitting disease with donor sclera. As I am sure that this text will reach a second edition, it might be useful to include formal protocols for ensuring that these risks are minimised, such as a cross checking procedure before enucleation and the relevant transplant authority guidelines for supply of sclera on a named patient basis.

    There are pearls for every level in this book, and I would strongly recommend it to trainees and established practitioners in general ophthalmology and oculoplastic surgery.

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